社区老年多病共存患者多重用药情况评价研究

Analysis and Evaluation of Multiple Drug Use among Elderly Patients with Multiple Chronic Conditions in Community

背景多病共存指同时患有2种或以上慢性病,是老年人群高发临床情况,尤为突出的是多重用药问题。多重用药带来了潜在不合理用药(PIM),是影响疾病预后的危险因素。对多重用药的评估、管理、优化是多病共存临床管理中非常重要的部分,可能是改善多病共存患者临床治疗效果、减少医疗费用的途径。目的回顾性分析社区老年多病共存患者多重用药情况,分析其影响因素。方法通过社区健康管理系统获得目前本社区2016年6月-2018年6月签约的≥65岁患者的基本资料,按国际疾病分类(ICD-10)标准进行系统分类统计,按照患2种及以上慢性病的定义,获取签约老年人中的多病共存患者。在老年多病共存人群中,根据随机数字表随机抽取400例患者进行多重用药(≥5种)情况调查,应用Beers标准及老年人处方筛查工具/老年人处方遗漏筛查工具(STOPP/START)标准,对所收集资料存在的PIM情况进行评估。结果社区多病共存患者占≥65岁老年患者总数的81.01%(10908/13465),多病共存的主要组合类型为:高血压+冠心病(22.0%)、高血压+糖尿病(15.8%)、冠心病+糖尿病(16.2%)。所调查的400份问卷,有效回收360份,其中271例患者存在多重用药情况,多重用药率为75.3%,平均用药种数5.7种,最多服用10种药物,服用的药物以心血管及内分泌疾病治疗药物为主。应用STOPP/START标准检出80例(22.2%)存在PIM,共计95项;检出18例(5.0%)存在21项潜在的遗漏用药;Beers标准检出57例(15.8%)存在PIM,共计72项。多因素Logistic回归分析显示,年龄、处方主要获得方式是PIM的影响因素(P<0.05)。结论多病共存在≥65岁老年人中患病率高,社区老年多病共存患者多重用药比例高,同时很大一部分存在不合理用药状况,高龄、未按期进行药物随访和评估、单科化的治疗模式可能是造成多重用药不合理用药的原因,作为管理多病共存主体的全科医生,应掌握不合理用药评估原则,改善多病共存多重用药的不合理用药情况。

Background Multiple chronic conditions(MCC)refers to patients having two or more chronic diseases with a high incidence among the elderly population clinically and especially the problem of multiple drug use.Multiple drug use has brought about potential irrational drug use,which is a risk factor affecting the prognosis of the disease.The evaluation,management and optimization of multiple drug use are very important parts of the clinical management of MCC.It may be a way to improve the clinical efficacy and reduce medical costs.Objective To analyze retrospectively the basic situation of multiple drug use in elderly patients with MCC and its influencing factors in the community.Methods Through the community health management system,the basic data of the elderly patients aged≥65 years old and signed with the community from June 2016 to June 2018 were obtained.According to the International Classification of Diseases(ICD-10),the data was classified and statistically analyzed.The elderly patients with two or more chronic diseases were defined as patients with MCC.Among them,400 patients were selected according to the random number table and enrolled in the multiple drug use(≥5 kinds of drugs)survey.Using Beers and STOPP/START standards to assess the potentially inappropriate medication(PIM).Results The patients with MCC accounted for 81.01%(10908/13465)of the total elderly patients over 65 years old.The main combinations of multiple chronic diseases were hypertension+coronary heart disease(22.0%),hypertension+diabetes(15.8%),and coronary heart disease+diabetes(16.2%).Of the 400 questionnaires distributed,360 were effectively recovered,including 271 patients had multiple medications with the multiple medication rate of 75.3%and an average number of taking 5.7 kinds of drugs,up to 10 kinds.The drugs taken were mainly based on cardiovascular and endocrine therapy.Using STOPP/START standard,80(22.2%)patients were detected with 95 items of PIM,and a total of 21 potential ointments were detected in 18 patients(5.0%),and 57(15.8%)items of PIM were detected by Beers standard.Multivariate Logistic analysis showed that age and the main methods of prescriptions were the influencing factors of PIM(P<0.05).Conclusion The prevalence of MCC in the elderly over 65 years old is high.The proportion of multiple drug use in community elderly patients with MCC is high,and there is a problem of irrational drug use.Advanced age,unscheduled drug follow-up and evaluation,and single treatment mode may be the cause of irrational use for multiple drugs.As general practitioners who manage MCC chiefly,it is necessary for them to grasp the principle of assessing irrational drug use and improve the PIM of multiple drug use.